死腔分数对急性呼吸窘迫综合征预后评估价值的研究
发布时间：2018-08-18 13:32
【摘要】：[目的]探讨死腔分数(VD/VT)对急性呼吸窘迫综合征(ARDS)患者预后的评估价值。[方法]采用前瞻性临床研究于2015年1月至2016年8月收集符合柏林标准的机械通气ARDS患者32例。自入EICU起连续6天测定PaC02、ETCO2,利用FrankenfieldDC等研究提出的公式,即死腔分数,VD/VT=0.320+0.0106(PaC02—ETCO2)+0.003(RR)+0.0015(Age)[1],计算 VD/VT,ARDS患者入EICU后行气管插管后充分镇静镇痛,调整PEEP至平稳状态后测定VD/VT,为第1天的死腔分数,同时采集患者一般情况、生命体征、急性生理和慢性健康评分(APACHEⅡ)、肺损伤预测评分(LIPS)、氧合指数(Pa02/FiO2)、静脉血二氧化碳分压(PvCO2)、PEEP、平台压,选用Epidata3.02软件包数据录入,采用双录入方式对试验数据进行录入,两次数据核对无误后,采用spss 20.0统计学软件包结合相关专业进行统计学分析。随访28天病死率;根据预后分存活组和死亡组,阐述死腔分数(VD/VT)在急性呼吸窘迫综合征(ARDS)患者预后评估中的相关性、特异性及灵敏性。[结果]32例ARDS患者纳入研究,死亡10例,存活22例,死亡率31.25%。ARDS患者发病6天内,VD/VT均升高,入院1-3天VD/VT两组间差异无统计学意义,而4-6天死亡组均高于存活组(P0.001),第4天VD/VT死亡组较存活组明显增高。存活组和死亡组VD/VT动态变化趋势比较,死亡组1-6天VD/VT逐渐升高(P0.001),而存活组1-6天VD/VT变化趋势差异无统计学意义。△VD/VT为28天独立危险因素(P0.05),ROC曲线显示:第4天预测ARDS预后的ROC曲线下面积(AUC)为0.961,以0.62为临界值预测预后的敏感性和特异性分别为:0.900和0.955,显著高于1天、5天、6天。与APACHEⅡ评分和LIPS评分比较,第4天V D/VT预测ARDS预后的ROC曲线下面积(AUC)为0.910,高于APACHEⅡ和LIPS评分,以0.62为临界值预测预后的敏感性和特异性分别为:0.916和0.955。第4天VD/VT更能准确的判断患者的预后。[结论]第4天死腔分数对ARDS患者预后评估有指导价值,与APACHE评分Ⅱ、LIPS评分相比,死腔分数对ARDS患者预后判断更有临床意义。
[Abstract]:[objective] to evaluate the prognostic value of dead chamber fraction (VD/VT) in patients with acute respiratory distress syndrome (ARDS). [methods] A prospective clinical study was conducted in 32 patients with mechanical ventilation (ARDS) who met Berlin standard from January 2015 to August 2016. PaC02ETCO2 was measured for 6 consecutive days from EICU. The formula proposed by FrankenfieldDC et al was used, that is, the dead chamber fraction was 0.0106 (PaC02-ETCO2) 0.003 (RR) 0.0015 (Age), and the patients with VD / VTARDS were given full sedation and analgesia after endotracheal intubation. After adjusting PEEP to a stable state, VD / V _ T was measured as the dead chamber fraction of the first day, and the general condition and vital signs of the patients were collected. Acute physiological and chronic health score (APACHE 鈪，
本文编号：2189623
[Abstract]:[objective] to evaluate the prognostic value of dead chamber fraction (VD/VT) in patients with acute respiratory distress syndrome (ARDS). [methods] A prospective clinical study was conducted in 32 patients with mechanical ventilation (ARDS) who met Berlin standard from January 2015 to August 2016. PaC02ETCO2 was measured for 6 consecutive days from EICU. The formula proposed by FrankenfieldDC et al was used, that is, the dead chamber fraction was 0.0106 (PaC02-ETCO2) 0.003 (RR) 0.0015 (Age), and the patients with VD / VTARDS were given full sedation and analgesia after endotracheal intubation. After adjusting PEEP to a stable state, VD / V _ T was measured as the dead chamber fraction of the first day, and the general condition and vital signs of the patients were collected. Acute physiological and chronic health score (APACHE 鈪，
本文编号：2189623
本文链接：https://www.wllwen.com/yixuelunwen/jjyx/2189623.html
最近更新
教材专著
